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Hepatitis C virus microelimination program in hemodialysis patients: success of a multi-stakeholder partnership based on a national eradication strategy.

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Title: Hepatitis C virus microelimination program in hemodialysis patients: success of a multi-stakeholder partnership based on a national eradication strategy.
Alternate Title: Programa de microeliminación del virus de hepatitis C en pacientes en hemodiálisis: éxito de una alianza multi-sector basada en una estrategia nacional de erradicación.
Authors: Ridruejo, Ezequiel1 (AUTHOR) eridruejo@cemic.edu.ar, Laham, Gustavo2 (AUTHOR), Alonso, Soledad3 (AUTHOR), Vallejos, Augusto4 (AUTHOR), Silva, Marcelo O.5 (AUTHOR), Ferder, Marcelo D.6 (AUTHOR), Dorado, Enrique G.6 (AUTHOR), Mauro, Ezequiel3 (AUTHOR), Puddu, Marcelo H.6 (AUTHOR)
Source: Medicina (Buenos Aires). nov/dic2025, Vol. 85 Issue 6, p1189-1197. 9p.
Subjects: HEMODIALYSIS, DISEASE eradication, HEPATITIS C, DIAGNOSTIC virology, ANTIVIRAL agents
Geographic Terms: ARGENTINA
Abstract: Introduction: Direct-acting antivirals (DAA) are highly effective in patients in hemodialysis and chronic hepa titis C and brings multiple benefits to this population. Our aim was to evaluate the effectiveness of DAA treat ment in routine clinical practice in Argentina using a multidisciplinary network. Materials and methods: In this prospective multi center cohort study, all patients on dialysis at Fresenius Medical Care, were screened for anti-HCV. All HCV RNA-positive patients were offered treatment with sofosbu vir/velpatasvir and glecaprevir/pibrentasvir. FIB-4 and APRI scores, and liver stiffness, were performed in all HCV RNA-positive patients. A network was developed where nephrologists, after an HCV management training program and under the supervision of hepatologists by telemedicine, initiated treatment in each dialysis unit; and DAAs therapy was provided by the patients' insur ance or by the national Ministry of Health. Results: A total of 10 144 patients were evaluated between January 2018 and December 2023. A total of 323 (3.2 %) were anti-HCV positive, of which 149/323 (46.1%) had detectable HCV RNA. Genotype 1 was the more prevalent (69%) and most patients had mild fibrosis (26% had F3-F4). By May 2024, 82 patients were evalu ated 12 weeks after the end of treatment 76 (92.7%) achieved sustained virological response, three died, one stopped treatment due to intolerance, and two were lost to follow-up. Discussion: A multi-stakeholder partnership model (Fresenius Medical Care, physicians, insurance compa nies and Ministry of Health), implemented as a national microelimination strategy, has demonstrated increased treatment rates for HCV in dialysis units, exhibiting ac ceptable effectiveness. Introducción: Los antivirales de acción directa (AAD) son altamente eficaces en pacientes en hemodiálisis con hepatitis C crónica (VHC) y aportan múltiples beneficios en esta población. Nuestro objetivo fue evaluar la efec tividad del tratamiento con AAD en la práctica clínica rutinaria en Argentina. Materiales y métodos: En este reporte de cohorte prospectivo y multicéntrico, se realizó tamizaje de an tiVHC en todos los pacientes en Fresenius Medical Care. A los pacientes con ARN detectable se les ofreció tra tamiento con AAD. Se les determinó los índices FIB-4 y APRI, así como la rigidez hepática. Se desarrolló una red donde los nefrólogos, bajo la supervisión de un hepató logo mediante telemedicina, empezaron el tratamiento; y los AAD fueron provistos por la cobertura médica o por el Ministerio de Salud de la Nación. Resultados: Entre enero de 2018 y diciembre de 2023, se evaluaron 10 144 pacientes; 323 (3.18%) fueron po sitivos para antiVHC, y 149/323 (46.1 %) tenían ARN detectable. El genotipo 1 fue el más prevalente (69%) y la mayoría presentaba fibrosis leve (26% F3-F4). Para mayo de 2024, 82 pacientes fueron evaluados 12 semanas después de finalizar el tratamiento 76 (92.6%) lograron respuesta virológica sostenida, tres fallecieron, uno interrumpió el tratamiento por intolerancia y dos se perdieron en el seguimiento. Discusión: Un modelo de alianza multi-actor (Frese nius Medical Care, médicos, cobertura de salud y Minis terio de Salud), implementado como estrategia nacional de microeliminación, ha demostrado un aumento en las tasas de tratamiento del VHC en unidades de diálisis, con una efectividad aceptable. [ABSTRACT FROM AUTHOR]
Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Hepatitis C virus microelimination program in hemodialysis patients: success of a multi-stakeholder partnership based on a national eradication strategy.
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  Data: Programa de microeliminación del virus de hepatitis C en pacientes en hemodiálisis: éxito de una alianza multi-sector basada en una estrategia nacional de erradicación.
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  Data: <searchLink fieldCode="AR" term="%22Ridruejo%2C+Ezequiel%22">Ridruejo, Ezequiel</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> eridruejo@cemic.edu.ar</i><br /><searchLink fieldCode="AR" term="%22Laham%2C+Gustavo%22">Laham, Gustavo</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Alonso%2C+Soledad%22">Alonso, Soledad</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vallejos%2C+Augusto%22">Vallejos, Augusto</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Silva%2C+Marcelo+O%2E%22">Silva, Marcelo O.</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ferder%2C+Marcelo+D%2E%22">Ferder, Marcelo D.</searchLink><relatesTo>6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dorado%2C+Enrique+G%2E%22">Dorado, Enrique G.</searchLink><relatesTo>6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mauro%2C+Ezequiel%22">Mauro, Ezequiel</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Puddu%2C+Marcelo+H%2E%22">Puddu, Marcelo H.</searchLink><relatesTo>6</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Medicina+%28Buenos+Aires%29%22">Medicina (Buenos Aires)</searchLink>. nov/dic2025, Vol. 85 Issue 6, p1189-1197. 9p.
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  Data: <searchLink fieldCode="DE" term="%22HEMODIALYSIS%22">HEMODIALYSIS</searchLink><br /><searchLink fieldCode="DE" term="%22DISEASE+eradication%22">DISEASE eradication</searchLink><br /><searchLink fieldCode="DE" term="%22HEPATITIS+C%22">HEPATITIS C</searchLink><br /><searchLink fieldCode="DE" term="%22DIAGNOSTIC+virology%22">DIAGNOSTIC virology</searchLink><br /><searchLink fieldCode="DE" term="%22ANTIVIRAL+agents%22">ANTIVIRAL agents</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22ARGENTINA%22">ARGENTINA</searchLink>
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  Label: Abstract
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  Data: Introduction: Direct-acting antivirals (DAA) are highly effective in patients in hemodialysis and chronic hepa titis C and brings multiple benefits to this population. Our aim was to evaluate the effectiveness of DAA treat ment in routine clinical practice in Argentina using a multidisciplinary network. Materials and methods: In this prospective multi center cohort study, all patients on dialysis at Fresenius Medical Care, were screened for anti-HCV. All HCV RNA-positive patients were offered treatment with sofosbu vir/velpatasvir and glecaprevir/pibrentasvir. FIB-4 and APRI scores, and liver stiffness, were performed in all HCV RNA-positive patients. A network was developed where nephrologists, after an HCV management training program and under the supervision of hepatologists by telemedicine, initiated treatment in each dialysis unit; and DAAs therapy was provided by the patients' insur ance or by the national Ministry of Health. Results: A total of 10 144 patients were evaluated between January 2018 and December 2023. A total of 323 (3.2 %) were anti-HCV positive, of which 149/323 (46.1%) had detectable HCV RNA. Genotype 1 was the more prevalent (69%) and most patients had mild fibrosis (26% had F3-F4). By May 2024, 82 patients were evalu ated 12 weeks after the end of treatment 76 (92.7%) achieved sustained virological response, three died, one stopped treatment due to intolerance, and two were lost to follow-up. Discussion: A multi-stakeholder partnership model (Fresenius Medical Care, physicians, insurance compa nies and Ministry of Health), implemented as a national microelimination strategy, has demonstrated increased treatment rates for HCV in dialysis units, exhibiting ac ceptable effectiveness. Introducción: Los antivirales de acción directa (AAD) son altamente eficaces en pacientes en hemodiálisis con hepatitis C crónica (VHC) y aportan múltiples beneficios en esta población. Nuestro objetivo fue evaluar la efec tividad del tratamiento con AAD en la práctica clínica rutinaria en Argentina. Materiales y métodos: En este reporte de cohorte prospectivo y multicéntrico, se realizó tamizaje de an tiVHC en todos los pacientes en Fresenius Medical Care. A los pacientes con ARN detectable se les ofreció tra tamiento con AAD. Se les determinó los índices FIB-4 y APRI, así como la rigidez hepática. Se desarrolló una red donde los nefrólogos, bajo la supervisión de un hepató logo mediante telemedicina, empezaron el tratamiento; y los AAD fueron provistos por la cobertura médica o por el Ministerio de Salud de la Nación. Resultados: Entre enero de 2018 y diciembre de 2023, se evaluaron 10 144 pacientes; 323 (3.18%) fueron po sitivos para antiVHC, y 149/323 (46.1 %) tenían ARN detectable. El genotipo 1 fue el más prevalente (69%) y la mayoría presentaba fibrosis leve (26% F3-F4). Para mayo de 2024, 82 pacientes fueron evaluados 12 semanas después de finalizar el tratamiento 76 (92.6%) lograron respuesta virológica sostenida, tres fallecieron, uno interrumpió el tratamiento por intolerancia y dos se perdieron en el seguimiento. Discusión: Un modelo de alianza multi-actor (Frese nius Medical Care, médicos, cobertura de salud y Minis terio de Salud), implementado como estrategia nacional de microeliminación, ha demostrado un aumento en las tasas de tratamiento del VHC en unidades de diálisis, con una efectividad aceptable. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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